Review Article

Dental implants from functionally graded materials

Mehdi Mehrali,1 Farid Seyed Shirazi,1 Mohammad Mehrali,2 Hendrik Simon Cornelis Metselaar,2
Nahrizul Adib Bin Kadri,1 Noor Azuan Abu Osman1
1

Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia
Department of Mechanical Engineering and Center of advanced Material, University of Malaya, Kuala Lumpur 50603,
Malaysia

Received 29 August 2012; accepted 4 January 2013

Published online 11 June 2013 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/jbm.a.34588
Abstract: Functionally graded material (FGM) is a heterogeneous composite material including a number of constituents that exhibit a compositional gradient from one surface
of the material to the other subsequently, resulting in a material with continuously varying properties in the thickness
direction. FGMs are gaining attention for biomedical applications, especially for implants, owing to their reported superior composition. Dental implants can be functionally graded
to create an optimized mechanical behavior and achieve the
intended biocompatibility and osseointegration improvement. This review presents a comprehensive summary of
biomaterials and manufacturing techniques researchers

employ throughout the world. Generally, FGM and FGM porous biomaterials are more difficult to fabricate than uniform or homogenous biomaterials. Therefore, our
discussion is intended to give the readers about successful
and obstacles fabrication of FGM and porous FGM in dental
implants that will bring state-of-the-art technology to the
bedside and develop quality of life and present standards of
C 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A:
care. V
101A: 30463057, 2013.

Key Words: functionally graded material (FGM), biomaterials,

dental implants, mechanical properties

How to cite this article: Mehrali M, Shirazi FS, Mehrali M, Metselaar HSC, Kadri NAB, Osman NAA. 2013. Dental implants from
functionally graded materials. J Biomed Mater Res Part A 2013:101A:30463057.

INTRODUCTION

The aim of modern dentistry is to restore the patient to

normal function, health, speech, and aesthetics. The dental
implants could be an only restoration option for people in
good general oral health who have lost a tooth owing to
periodontal disease, an injury, or some other reasons. The
most common cause for failure in dental implant is inadequate bone formation around the biomaterial immediately
after implantation.1 Therefore, the development of new biomaterials for dental implants is one of the challenging tasks
for materials science today. A single composition with a uniform structure cannot satisfy the requirements for some
biomedical applications as dental biomaterials must meet
several important criteria and have properties such as biocompatibility with a known degradation rate, osteoconductivity, strength, corrosion resistance, elastic modulus, fatigue
durability, and close chemical similarity to biological apatite
present in human hard tissues.25 Hence, in the eld of biomedical implants, we often observe a number of designs

produced both from conventional engineering and tissue engineering. Nowadays, bone implant research is mainly
focused on four areas: (1) composites, (2) polymeric coatings on metallic implants, (3) tissue engineering, and
recently (4), functionally graded material (FGM).6
FGMs, rst proposed in 1986 in Japan, represent a novel
idea for the realization of innovative properties and/or functions that conventional homogeneous materials cannot accomplish.7,8 One extraordinary feature of biomaterials is the
formation of gradable structures. Therefore, FGMs are useful
as the composition of tissue shows a continuous change
from one composition to another.9 For example, the suitable
design of porous bone with a porosity gradient from a
dense, stiff external structure (the cortical bone) to a porous
internal one (the cancellous bone), and with an adequate
degree of interconnectivity exhibits that functional gradation
is applied by biological adaptation.1012
In the case of dental implants, the components are usually much smaller and used to reconstruct the masticatory

Correspondence to: F. S. Shirazi; e-mail: f.shirazi@siswa.um.edu.my

Contract grant sponsor: Ministry of Higher Education (MOHE) of Malaysia; contract grant number: UM.C/HIR/MOHE/ENG/10 D000010-16001
Contract grant sponsor: Institute of Research Management and Consultancy (IPPP), University of Malaya; contract grant number: PV008/2012A

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C 2013 WILEY PERIODICALS, INC.

V

REVIEW ARTICLE

FIGURE 1. View of an FGM dental implant with graded material composition in the maxilla.13 [Color figure can be viewed in the online issue,
which is available at wileyonlinelibrary.com.]

function when a tooth root is wholly extracted or lost. The

implant is located in the jaw bone in a manner to penetrate
from the inside to the outside of the bone. The required
function of a dental implant varies at the outside of the jawbone, inside it, and at jawbone boundary.13 On the outside
of the bone, the implant material needs to have sufcient
mechanical strength to bear the occlusal force, whereas the
part inside the jawbone must have stress relaxation, osteoconductivity, and adequate bone-implant contact so that the
new bone is created speedily and attaches directly to it.
Nowadays, dental implants use single materials sometimes
with a bioactive coating layer. The problems associated with
the current, coated metallic implants consist of stress
shielding of the surrounding bone and poor survival of coatings over time, resulting in severe biocompatibility
issues.6,14 The theory of stress shielding hypothesizes that
bone loss around orthopedic and dental implants is owing
to the removal of normal stress from the bone by an
implant.15 To improve the dental implants acceptance
inside the living bone, the concept of FGM should be a
favorable approach.16,17 The primary advantages of using
FGM dental implants include: (1) improvement of biocompatibility,18 (2) diminution of the stress shielding effect on
the surrounding bones that regularly occurs in the presence
of fully metallic implants,1921; (3) precluding the thermal
mechanical failure at the interface of hydroxyapatite (HA)coated metallic implants,22 and (4) improving the biomechanical requirement and controllability for graded bioreaction at each region of the bone.23 All these aspects of using
FGM implants are discussed in this review. So far, functionally graded dental implants use a variety of materials such
as titanium (Ti), HA, titanium nitride (TiN), polymer, zirconia (zirconium dioxide, ZrO2), and so on. In this review article, we consider materials and fabrication techniques used
in this application eld in recent years. Furthermore, the

JOURNAL OF BIOMEDICAL MATERIALS RESEARCH A | OCT 2013 VOL 101A, ISSUE 10

design of functionally graded dental implants and optimization is also a subject of this review.
THE STRUCTURE OF FUNCTIONALLY GRADED DENTAL
IMPLANTS

Many natural tissues and organs are not homogeneous

materials, and observations show their structures to be
functional gradients, for example mollusk shells, bamboo,
bone, and skin.2426 Tissues or organs are described as
functionally graded if each layer of the tissue or organ has
one or more particular functions to achieve the local functional requirements. Therefore, to regenerate the natural
functionality, a successful conception of dental implant
should also include FGM.5,17,2730 Figure 1 shows a schematic view of an FGM dental implant with graded material
composition used in dentistry.
For FGM dental implant purposes, a cylindrical shape
was designed with composition varying in the axial direction. The upper part has more strength and mechanical
properties necessary as the occlusal force is applied directly
on the top and then transmitted down to lower parts
implanted inside the trabecular bone where more biocompatible materials are desirable.6,31,32 Mostly, implant failure
is owing to the lack of biomechanical bonding between the
implant and the surrounding jawbone; therefore, the lower
parts should have a high osteoconductivity and have a good
bone-to-implant contact for regenerating bone and rapid
osseointegration.20,3335 Also, the implants might fail owing
to insufcient strength and mechanical properties or overload. Consequently, a possible solution is to design adequate
mechanical properties in the upper parts of FGM dental
implants.3437 As discussed in detail above, when considering an implant design, the use of FGM is expected to
improve both the mechanical and the biological performance of dental implants.

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TABLE I. Materials and Bone Properties

Materials

Youngs
Modulus (GPa)

Poissons
Ratio

Density
(kg/m3)

Cortical bone
Cancellous bone
Enamel
Dentin
Ti
HA
TiN

14
3
10.5
19.7
110
40
251

0.3
0.3
0.33
0.33
0.35
0.27
0.29

1700
270
2906
1800
4500
3219
5300

Co
ZrO2
SiO2

210
200
75

0.31
0.31
0.17

8900
6000
2200

CHALLENGES FOR MATERIALS

In the last few years, a variety of biomaterials and bioceramics were investigated for FGM dental implants such as
Ti/HA,16,17,38 titanium/cobalt (Ti/Co),39 Ti/ZrO2,40 titanium/silica (Ti/SiO2),41 and TiN/HA.42,43 Table I summarizes the Youngs modulus, Poissons ratio, mass density of
bone, and material densities for reference.19,31,4453 Studies
have shown that Ti and its alloys are among the most successful metallic biomaterials for dental and orthopedic
applications because of their good mechanical properties
(elastic modulus, toughness and fatigue, strength), excellent
corrosion resistance, and good biocompatibility.5860 However, Ti and Ti alloys are bioinert and cannot promote tissue
bonding to the implants. Generally, a dental implant should
have sufcient mechanical strength to maintain integrity;
for this reason, Ti and Ti alloys were used along the longitudinal direction from Ti, which is rich in the upper parts
where occlusal force is directly applied to ceramics or metals rich in the other material that is implanted inside the
jawbone.
Watari et al.39 investigated Ti/Co FGMs. They evaluated
the mechanical properties and biocompatibility for implants.
They reported that in the implantation analysis of Ti/Co
into the soft tissue, a thin brous connective tissue was
formed in the pure Ti region while the thickness of the brous tissue layer increased with the Co concentration, leading to inammation problems at the Co-rich part. Therefore,
the COs change of concentration seemed to affect the biocompatibility of implant material. Other clinical studies also
indicated that epithelial cells as well as broblasts have a
stronger negative response to a Co-chrome alloy than to
Ti.61 In this context, Co exhibited several advantages in mechanical properties, wear resistance, and good corrosion
resistance.
Takahashi40 studied the use of Ti/ZrO2 FGM for dental
implants. Zirconia appears to be an appropriate dental
implant material because of its tooth-like color, biocompatibility, and good mechanical properties in strength and fracture toughness.62 The inammatory reaction and bone
resorption provoked by zirconia particles are less than
those inuenced by Ti particles; therefore, ZrO2 is suitable

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MEHRALI ET AL.

Reference
44

Rho et al.
Rho et al.44
Dowker et al.45 and Kitagawa et al.46
Kitagawa et al.47 and Angker et al.48
Benzing et al.49 and Lin et al.50
Hedia and Mahmoud19
Stone et al.51, Sherif El-Eskandarany et al.52,
and Namazu et al.53
Marti54
Gahlert et al.55 and Andreiotelli and Kohal56
Zhou et al.57

for long-term use in vivo.6365 Recently, Fujii et al.66,67

described the successful preparation of partially stabilized
zirconia (PSZ) and pure Ti FGM by the hot pressing of powder. Fujii et al. evaluated the mechanical properties such as
bending strength, Youngs modulus, and Vickers hardness.
One of the results was that the bending strength and Vickers hardness decreased with increasing Ti content in the
PSZTi because the strength and hardness of 100% PSZ are
much higher than those of pure Ti. The Youngs modulus
increases from pure PSZ to 20% Ti content and then
declined with increasing Ti. Also, they found that brittle
fracture occurred after elastic deformation except for pure
Ti.66 Figure 2 shows the fracture surfaces in SEM micrographs. They reveal that transgranular fractures occurred in
the PSZ and Ti phases. It is worth noting the brittle fracture
surface is detected even in the Ti-rich region.
Takahashi et al.41 carried out the synthesis of Ti/SiO2
FGM for dental work in 1992. Some studies reported that
silica is believed to play a critical role in bioactivity of bioactive materials for the bonding of bone and muscle and as
a crosslinking agent in connective tissue.6870 There are
three functions of silica. (1) Silica performs a specic metabolic function that is thought to partake in cellular development and gene expression.7173 (2) There is a chemical
function in which the bonding to bone is established by the
precipitation of apatite surface layer that must be formed
on the bioactive silica-based glasses surface when in contact
with in vivo applications or simulated body uid.71,74,75 The
in vitro studies observed that composites containing bioactive glassceramic (BGC) nanoparticles with lower phosphorous and higher silica content have better bioactivity than
that of the BGC with higher phosphorous and lower silica
content.76,77 (3) There is a mechanical function as silica particles showed to improve the strength of a HA coating by
particle-mediated reinforcement, leading to crack deection
or crack arrest. Amorphous SiO2 is a good candidate to
enhance the mechanical properties of HA coatings.68
HA is one of the best among the bioactive materials as it
can bond to human bone because osteoblast cells penetrate
into HA. Therefore, HA is clinically applied to the teeth.7880
However, the mechanical strength of HA is remarkably low

DENTAL IMPLANTS FROM FGM

REVIEW ARTICLE

FIGURE 2. SEM micrographs of fracture surface of PSZ-Ti.66

and the application of HA to teeth was limited.8183 Another

study by Watari et al.16,17 used HA and Ti to prepare FGM
dental implants. This team reported that a good combination of HA and the mechanical properties of Ti is considered
as a promising approach to fabricate suitable FGM dental
implants. During sintering of Ti/HA FGM, the HA is not
decomposed at 850
C.42 On the other hand, this temperature is too low for sintering HA and mechanical properties
did not develop. Kondo et al.42 used TiN to improve the sintering of HA at higher temperature. They reported that by
using TiN instead of Ti, the decomposition of HA can be
suppressed. However, the sintering of the TiN-rich region
was still inadequate for the temperature up to 1200
C.
To avoid these problems, researchers have used different
fabrication techniques. In the following sections, there is a
review of the processing methods to fabricate FGM dental
implants. As mentioned earlier, PSZ has good biological
compatibility and a high mechanical strength; however, it is
not expected that PSZ embedded as an articial bone combines with a bone because it has no osteoconductivity.
When a material devoid of osteoconductivity is applied for
bone implantation, there is a gap between the material and
the bone that grows with the passing of time and causes
both pain and abrasion of the material.
Many have carried out several investigations to solve
this problem by producing a composite of HA and PSZ.8486
Matsuno et al.87 reported that a laminated HA/PSZ-sintered
composite with a gradient composition can be produced
from HA and PSZ. This study said to expect wide reception
of HA/PSZ gradient composition as a biomaterial for hard
tissue because it has osteoconductivity and high mechanical
strength. Guo et al.88 have used yttria-stabilized tetragonal
zirconia (Y-TZP) to develop functionally graded HA/ZrO2
composites. The authors reported that HA/Y-TZP functionally graded composites showed considerable improvement
in mechanical properties, whereas the HA phase in the composite layers was stable up to 1200
C and the Y-TZP second
phase remained the tetragonal zirconia (t-ZrO2) phase after
processing at the highest temperature of 1250
C. Figure 3 is
a back-scattering electron (BSE) micrograph of a cross-section of the HA/Y-TZP FGM. The microhardness and the
Youngs modulus increased stepwise from the pure HA layer

JOURNAL OF BIOMEDICAL MATERIALS RESEARCH A | OCT 2013 VOL 101A, ISSUE 10

to the HA 40 wt % Y-TZP layer across the HA/Y-TZP functionally graded composites as shown in Figure 4(a,b).
Besides the FGM dental implants discussed above, porous functionally graded biomaterial such as Ti and its
alloys also work. Nowadays, most oral implants are fabricated from Ti-6Al-4V (90% Ti, 6% aluminum, and 4% vanadium) and pure Ti. Although Ti and its alloys have good
physical, mechanical properties, corrosion resistance, and
biocompatibility,89,90 the stiffness of metallic dental implants
is not well-adapted to bone. This situation leads to stress
shielding from the residual bone, which may result in detrimental resorptive bone remodeling.91 The stiffness of a
metal is determined by the Youngs modulus of the material
used as well as its area of moment inertia. In the case of Ti
dental implants, the Youngs modulus is far higher than that
of cortical bone as summarized in Table I.44 Therefore, it is
proposed that the level of porosity is gradable, from a more
porous surface layer to a denser core, giving the potential
to have the same stiffness of the bone tissue at the
implantbone interface.92,93
Hirschhorn94 in the 1970s used the concept of functionally graded porous biomaterials to fabricate femoral stems.
However, the study appeared abandoned owing to the

FIGURE 3. BSE
composite.88

image

of

the

HA/Y-TZP

functionally

graded

3049

FIGURE 4. (a) Microhardness and (b) Youngs modulus as a function of Y-TZP content for the HA/Y-TZP functionally graded composites by
SPS.88

concerns over poor fatigue performance until a resurgence

of interest in 1995 by Becker et al.95 Becker investigated
the mechanical properties of different biomedically
approved alloys such as 316L stainless-steel, Co-29Cr-6Mo
alloy, and Ti-6Al-4V alloy.95 Becker and Boltons study92
showed that it is possible to use porous FGM Ti alloys for
orthodontic or maxillofacial implants.
It is possible to alter and optimize mechanical properties
of porous materials in dental implants by controlling porosity, pore size, and pore distribution. Oh et al.96 investigated
the effects of different pore sizes in vitro and in vivo and
found a suitable size range of 515 lm for broblast
ingrowth, 70120 lm for chondrocyte ingrowth, and 100
400 lm for bone regeneration, depending on the porosity as
well as scaffold materials. Meanwhile, the surface microstructure of dental implants is another crucial design feature.
Some have reported that rough surfaces can promote better
and faster bone apposition as they are more osteoconductive
than smooth surfaces.97 Wong et al.98 and Carlsson et al.99
reported that a surface with Ra between 1 and 10 lm was
optimal for promoting bone apposition and stimulating mesenchymal cell differentiation into functional osteoblasts.

The following section outlines the various fabrication

methods of porous FGM for dental implants and provides
an indication as to how far they can provide control over
these parameters. Different synthesis methods for FGM dental implants are focused in the next section.
FABRICATION TECHNIQUES AND MECHANICAL BEHAVIOR
FOR FUNCTIONALLY GRADED DENTAL IMPLANTS

In this section, we discuss the processing methods to fabricate FGM dental implants and their mechanical behavior.
There are several methods for the fabrication of FGM and
porous FGM dental implants as summarized in Table II.
Functionally graded dental implants containing
Ti and TiN
Ti/HA FGM can make a promising material for tissue implantation, orthopedic, and dental applications because of
its outstanding biocompatibility and bioactivity. As mentioned above, different fabrication methods are used such as
cold isostatic pressing (CIP), spark plasma sintering (SPS),
hot pressing, and powder metallurgy (PM). Watari et al.17 in
1997 showed the synthesis of HA/Ti as an FGM dental

TABLE II. Materials and Fabrication Techniques

Functionally Graded
Dental Implants
Ti/HA
TiN/HA
Ti/Co
Ti/SiO2
Ti/ZrO2
HA/ZrO2
Porous FGM

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MEHRALI ET AL.

Fabrication Methods
CIPEF, CIPHF, SPS,
PM, hot pressing
SPS
PM
CIPHF
CIPHF, hot pressing
SPS, hot pressing
PM, one-step microwave,
PECS, LENSTM, and DLMS

References
16

Watari et al. , Fujii et al.66, Watari et al.100,

Chu et al.101, and Chenglin et al.102
Kondo et al.42
Watari et al.39
Watari et al.16 and Takahashi et al.41
Takahashi40 and Fujii et al.66
Guo et al.88
Matsuno et al.87, Traini et al.93, Kutty and Bhaduri103,
Suk et al.104, and Krishna et al.105

DENTAL IMPLANTS FROM FGM

REVIEW ARTICLE

FIGURE 5. Change of Brinell hardness with HA content in Ti/HA FGM

sintered by EF at 1300
C and SPS at 850
C.16

implant using CIP and sintered by high-frequency induction

heating to satisfy both mechanical and biocompatible properties. Watari et al.16,38,100 tried CIP, sintered electric furnace (EF) heating and SPS methods for sintering. In the EF
sintering, powders were packed into the thermo-contractive
tube after heat treatment of a tube at 60
C, which was then
compressed by CIP at 8001000 MPa, and the implants of
the miniature cylindrical shape were densied by sintering
in a vacuum at 1300
C. In the high-frequency induction
heating, they packed powders into the thermo-contractive
tube or silicone rubber impression mold with the shape of a
dental implant. After CIP, the packing was sintered at above
1300
C in Ar gas atmosphere. For SPS process, the mixed
powders of Ti hydrate and HA were put into a graphite
mold with the gradient composition ranging from 100% Ti
to pure HA in the height direction and sintered at 850
C at
a pressure of 40 or 80 MPa. Watari et al. reported that Ti/
100HA FGM decomposition in the sintering process is signicant. Internal stress also arises from the difference of
thermal expansion coefcient and shrinkage at the interface
from one region to other. Moreover, they lowered the sintering temperature by using SPS to avoid autodestruction.
There was much improvement in sintering by SPS compared
with the conventional CIP and furnace sintering methods.
Fracture of the FGM occurs near the weakest region or
its neighbor. In the three-point exural test of Ti/HA FGM
prepared with SPS at a pressure of 40 MPa, fracture
occurred deviated from the center in the HA-rich side,
which is weaker. In the FGM prepared with 80 MPa, fracture
occurred inside the single layer in the center. The exural
strength was increased to 36 MPa and the compressive
strength 88 MPa, respectively. The Brinell hardness test
observed for FGM sintered by SPS and EF in Figure 5 shows

JOURNAL OF BIOMEDICAL MATERIALS RESEARCH A | OCT 2013 VOL 101A, ISSUE 10

the decreasing tendency of the hardness in the direction of

the tooth root region in SPS contributes to the stress relaxation, which relieves the jawbone from damage by imposition
of high spike of impact stress near the implant.
It is important to control the temperature distribution in
a work piece during and after sintering in SPS and the residual stress distribution at the interface of each layer after
sintering to obtain the desired mechanical properties. Sasaki
and Asaoka106 investigated and analyzed the effects of temperature distribution and residual stress at the interface of
each layer in SPS sintering by nite element method (FEM)
to develop an optimization approach for conducting optimum production conditions. FEM analysis can be used with
SPS method to simulate the whole heating process in a
manner comparable to the actual experimental experience,
where a controllable heating rate, variable die size, and
pressure are implemented.107,108 They reported that the
measured residual stress was higher than that predicted
from FEM. This group also observed that hardness
increased, whereas fracture toughness and bending strength
decreased with rising HA content.
Chu et al.109 investigated HA/Ti biomaterial FGM by
employing a hot-pressing method without bending deformation and microcracks parallel to the graded direction of the
FGM on the surfaces. Chu et al.101 developed HA/Ti FGM by
optimizing the best combination of their biocompatibility
and mechanical properties. In their method, they rst examined the thermoelastic properties of uniform HA/Ti related
to each graded layer of the FGM. In their results, the thermal expansion coefcients of the HA/Ti increased with the
rise in temperature or content of HA, and the residual thermal stress was conrmed by an X-ray and theoretical
method. They have also used powder metallurgy to produce
HA/Ti FGM sintered at 1100
C.102 In this method, hardness
grew with increasing volume fraction of HA as opposed to
SPS sintering in which the hardness decreased. It is important to note that the Youngs modulus is higher than natural
bones in all regions of Ti/HA FGM that can cause severe
stress concentration, namely load shielding from a natural
bone, which may weaken the bone and deteriorate the
implant/bone interface. Chu et al. reported that the existence of Ti can promote decomposition of HA at the sintering temperature (1100
C). The decomposed phases are aCa3 (PO4)2 and Ca4P2O9. However, no new compounds form
between HA and Ti.102
Kondo et al.42 studied TiN/HA functionally graded
implants by SPS method. They reported that by using TiN
instead of Ti and sintering at 1100 and 1200
C, the decomposition of HA is suppressed. It was found that the mechanical properties TiN/HA are comparable to Ti/HA obtained by
SPS and are sufcient for practical use. The Brinell hardness
was around 60, whereas the hardness in the HA region did
not decrease. The exural strength of TiN/HA sintered at
1100 and 1200
C was 65.4 and 71.3 MPa, respectively, and
the compressive strength of TiN/HA FGM was more than
100 MPa. However, the sintering of the TiN-rich region was
still insufcient even at 1200
C. They observed little inammatory reaction at the TiN part in animal experiments.

3051

Watari et al.39 produced Ti/Co FGM by powder metallurgy using both a wet technique to produce a gradient by
differentiated sedimentation in a solvent liquid and a dry
method to pack mixed powders gradiently into a mold, followed by CIP, and sintering at 1300
C. The Ti/Co FGM
specimens were implanted in the subcutaneous tissue of
dorsal part of rat and after implantation were evaluated
from histological observation by optical microscopy. One of
the evidences of infection is pus formation that is a result
of macrophages and neutrophils, which die after killing the
foreign parasites. To avoid the spread of infection, brous
tissues usually form around the pus.110 The thickness and
texture of brous tissues created around the implant can
depend on the type of implant material, shape and size of
the implant, site of surgery in terms of functionality, and
type of tissue that needs to be healed.111 Watari et al.39
have found that the thickness of the brous connective layer
is small in the pure Ti region. However, the thickness of the
brous connective layer increased with Co concentration
along the longitudinal direction of the FGM. It was also
observed that more inammatory tissue and necrosis
occurred near some Co-rich parts.
Takahashi et al.41 manufactured Ti/SiO2 FGM dental
implants by CIP method and then sintered in argon gas by
high-frequency induction heating at a temperature of
1300
C. This group reported that the fracture stress
changed from 2000 MPa in pure Ti to 100 MPa at the ceramic content. In their research, they also used Ti/ZrO2
FGM for dental implants40 by following the same method as
mentioned above for Ti/SiO2. It was found that at the same
volumetric content, the Tizirconia composite showed the
same exural strength as the Tiapatite composite and
higher values of elastic modulus and strain. It was shown
that the sintering at higher ceramic contents could improve
by adding 5% of Pd to the Ti.
Recently, Fujii et al.66 developed Ti and PSZ FGM using
hot pressing. The Youngs modulus and Vickers hardness
were higher in the full range of Ti than predicted from the
rule of mixture, and the bending strength decreased with
increasing Ti content as the strength of pure PSZ is much
higher than that of pure Ti. According to the X-ray diffraction (XRD) analysis, the sintering process created reaction
products such as Ti oxide, and these reactions inuenced
the mechanical properties.66 It is often stated that there are
different stoichiometrics in Ti oxide which are TiO2, TiO,
Ti2O3, Ti3O2, Ti3O5, TiO0.325, and TiO0.5, and it seems that
the Youngs modulus depends on the stoichiometrics.112
Hence, various Youngs modulus of Ti oxide have been
reported.67,113 Hence, the mechanical properties of the Ti/
PSZ FGM could not be explained by the rule of mixture.
Teng et al.114 reported that there was no reaction product
in the Ti/ZrO2 interfaces fabricated by hot pressing,
whereas according to the thermodynamic analysis, it is predictable that Ti can react with ZrO2 in the synthesis processes of Ti/ZrO2 FGM, and the bonding state between Ti
and ZrO2 is physical in the composite. The XRD results were
demonstrated that the volume fraction of Ti in the composites has remarkable effect on the phase transformation

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MEHRALI ET AL.

FIGURE 6. Schematic diagram showing a cross-section of a disk

specimen of the HA/Y-TZP functionally graded composite, consisting
of symmetric layers with graded compositions.88

from t-ZrO2 to monoclinic zirconia (m-ZrO2). Under the

same sintering conditions, the volume fraction of m-ZrO2
increases with the increase of Ti content.114 In high-temperature sintering at 1500
C, studies with 90 mol % Ti showed
that ZrO2 particles were almost completely dissolved
in Ti, being accompanied by simultaneous precipitation
of Y2Ti2O7.115

Functionally graded ceramicceramic materials

Guo et al.88 described the successful preparation of HA/
ZrO2 FGM which is useful for dental implants at 1200
C
within 5 min by the SPS method and found that equiaxial YTZP grains uniformly dispersed in the HA matrix. They
showed88 that there was no phase change of HA in the composites sintered at 1100
C, but HA started to decompose
into a-TCP at 1200
C. On the other hand, the Y-TZP
remained the t-ZrO2 phase even after the maximum temperature of 1250
C. A thin layer of CaZrO2 phase was found on
the interfaces among HA grains and zirconia grains. The
Youngs modulus of these FGM grew with increasing zirconia content and sintering temperature up to 140 GPa sintered at 1100
C and 160 GPa at 1200
C, which is high compared to Ti/HA. Guo et al.88 reported that the bending
strength of the composites SPS at 1200
C reached 200 MPa,
which is double the strength of pure HA ceramics. It has
enough durable strength in the clinical practice. Matsuno
et al.87 have also investigated HA/ZrO2 FGM by hot pressing,
but the signicant difference between the Guo study and
the Matsunos study was the design and arrangement of the
individual layers. Guo et al.88 designed the pure HA layer as
the middle layer and the HA 40% Y-TZP layers on both
ends of a prepared disk as shown in Figure 6. This designs
use introduces compressive stresses that can be developed
on both ends of the disks, and there were no long microcracks observed in their spark plasma-sintered samples. The
microcracks are the direct evidence of thermal stresses
owing to a cooling process from a high temperature to
room temperature and are generally present in both composites and coatings. Guo et al.88 reported that the tensile
stress developed in the HA layer because of its higher

DENTAL IMPLANTS FROM FGM

REVIEW ARTICLE

thermal expansion coefcient than that of the ZrO2 layer,

and therefore causing the microcracking in the HA layer.
Porous FGM dental implants
The simplest fabrication technique for manufacturing porous FGM dental implants is based on the partial densication during sintering of metal powders. This method is
known as powder metallurgy. Thieme et al.116 produced porous Ti FGM destined for orthopedic implants with a porosity gradient perpendicular to the surface by a powder metallurgy technique. The porous FGM demonstrated adequate
Youngs modulus in the range of 580 GPa so that it is
adapted to the elastic properties of bone with the purpose
of avoiding stress shielding effects and to present better
long-term performance of the implant-bone system. The
results indicated that the modulus is inversely connected
with the porosity gradient.116
Kutty and Bhaduri 103 developed a graded porosity on
the surface while maintaining a dense core in a Ti sample.116 In their research, the synthesis was carried out in a
semi-industrial grade microwave cavity using a-SiC susceptor. The Ti samples were sintered at 1, 1.25, and 1.5 kW for
30 min. The result was that a pore size in the range of 30
100 lm is ideal for broblast ingrowth.12 A mechanical
study showed the highest strength of about 400 MPa when
the samples were sintered at 1.25 kW for 20 min and this
value is close to bulk CP Ti (345550 MPa). In addition,
FGM porosity and the graded nature of change from dense
core to porous surface should result in a better stress transfer than a coated surface. Therefore, a one-step processing
technique works for fabricating various implants and dental
implants. A pulsed electric current sintering (PECS) process
exists for the production of porous structure with a porosity
gradient in the micrometer size.106 PECS permits more
rapid sintering at lower temperature than conventional sintering, primarily by means of a spark pulse current that
forms between the powder particles.117
Suk et al.104 used a pressureless PECS method for manufacturing porous FGM, and the obtained specimen has a
gradual change in pore distribution. This experiment was
carried out without rapid and strong neck formation and
with no volume shrinkage. The major interest in this process is where to obtain good pore interconnectivity, easy porosity control, and short processing time, but low porosity
and expansiveness.12,104 Figure 7 shows the graphite mold
used in the PECS technique for the preparation of the porous material with a porosity gradient. Three K-type thermocouples at various positions, as shown in Figure 7 (positions 13), checked the temperature difference along the
longitudinal direction within the graphite mold. This process
conrmed that a suitable temperature gradient was established for preparing the porous structure with a porosity
gradient of reasonable degree. Sintering was generally performed with a thermocouple inserted completely into the
hole at position 2, the temperature of which was taken as
the signicant sintering temperature.
Laser-Engineered Net Shaping (LENSTM) is a technique
able to obtain gradient structures and can also produce net-

JOURNAL OF BIOMEDICAL MATERIALS RESEARCH A | OCT 2013 VOL 101A, ISSUE 10

FIGURE 7. Schematic illustration showing the graphite mold used in

the PECS process: (1) specimen (powder), (2) die, and (3) punch.
Holes for inserting thermocouples are located at positions 13.104

shaped implants with designed porosities and can extend to

other metallic biomaterials as well.118,119 Krishna et al.105
used LENS to produce porous Ti implants with mechanical
properties matching those of natural bone. They reported
the bulk density and porosity of these samples varied,
depending on the LENS-processing parameters.105 Youngs
modulus increased linearly with increasing density of the
samples. The experimental data indicate that the modulus
and strength of laser-processed Ti specimens can be tailored in the range of 245 GPa and 21461 MPa, respectively, whereas the porosity was in the range of 3542 vol
%, close to those of human cortical bone. They also
observed that it is possible to fabricate porous Ti samples
with a porosity higher than 40 vol % that have appreciable
mechanical properties, whereas in other literatures, it was
reported that the strength of compacts with a porosity
higher than 40 vol % is diminished to approximately 0
MPa.120,121 Generally, the important points in this process
are good pore interconnectivity, control over porosity, and
ability to realize complex shapes. However, this technique is
limited to small pore sizes.
More recently, the development of direct laser metal sintering (DLMS) processes has considerably increased the
eld of application of Ti alloys and allowed implants to be
fabricated more economically in comparison with traditional
techniques. Among the several direct metal-forming techniques, selective laser sintering promises great potential benets in the eld of the biomaterials, especially in implant
dentistry, owing to its capability to directly build threedimensional (3D) metallic components from metal powder
with minimal or no postprocessing required.122,123 Traini
et al.93 used DLMS and subsequently modied it with acidetching methods to improve the surface microstructure for
the production of isoelastic FGM for porous Ti dental
implants. In their research, the original surface consisted of
spherical particles in the range of 550 lm. In the next
steps, they used different etching techniques using inorganic
and organic acids. It was observed that after exposure to
hydrouoric acid, some of the spherical particles were
removed and the microsphere diameter was in the range of
5.126.8 lm. After an organic acid treatment, grooves from
14.6 to 152.5 lm in width and 21.4102.4 lm depth

3053

FIGURE 8. SEM images at 500 magnification of surfaces fabricated disks after different treatments. (a) Untreated disk; (b) disk treated with
hydrofluoric acid; and (c) disk treated with organic acid.93

replaced particles. The SEM images of the surfaces DLMSfabricated disks after different treatments are shown in
Figure 8. Moreover, they assessed the variation of surface
roughness by use of a Chi-square test. It is important to
control the surface morphology of the dental implants to
obtain the desired surface roughness and the wettability to
allow the absorption of plasma proteins on the implant surface.124 Youngs modulus of the exterior porous Ti was 77
6 3.5 GPa, but the mean of porosity was 28.7% of the metal
surface, and that of the inner core Ti was 104 6 7.7 GPa.
The fracture face indicated a dimpled appearance typical of
ductile fracture. However, the method is also limited in the
arrangement and the control of pore size that can be
fabricated.

FUTURE CONSIDERATIONS

For nearly all dental implants, the main goals are rapid
return to function (i.e., mastication), stronger, safer osseointegration, and long-term xation of implants to bone. To
achieve these goals, designers of dental implants must confront biomechanical and biomaterials subproblems, including in vitro and in vivo performances on implants, mechanical compatibility to smooth transfer the stress between the
placed implant root and the receiving hard tissue, and interfacial tissue response. As a promising candidature, FGM can
be applied to improve the success of dental implants while
there are no many examples of actual FGM dental implants
that have been used in clinical applications. The hurdle may
be the producing cost and transferring the techniques to
shape of a dental implant, which will prevent the realization
of the potential of functionally graded dental implants. In
our research to create the ideal implant designed with
FGMs approaches, we are required to close key gaps in our
basic knowledge and make a series of prototype dental
implants with increasing functionality. We must start by distinguishing the specic gaps, in our present knowledge, and
then look widely for advances that will facilitate us to link
them. We must try to uncover the relationships linking composition and biomaterials architecture in functionally graded
dental implants with mechanical behavior, length scales, and
the capability for osteogenesis. Finally, these relationships
should be tested and evaluated systematically in vivo and
nally in clinical studies.

3054

MEHRALI ET AL.

Although many biomaterials and ceramics can be made

into the FGM and gradient porous dental implants, but so
far they have received little attention and still need for
improvement. For example, recently bioactive glass scaffolds
with strengths comparable to those of cortical bone have
been produced. Therefore, these bioceramics may have
potential for the FGM in dental implants. But, the mechanical properties and reliability of BG remain as limiting factors for applications in dental implants; however, still more
consideration is needed for development.
The study of the literature suggests that many different
parameters might be important for the long-term osseointegration and better performance in bone, where the goal can
be achieved by lowering the FGM material gradient. But, it
is well established that this will, at the same time, decrease
the stiffness of implantation, as a result locating the bone
implant interface at higher risk of damage during the early
healing stage. The problem might be minimized by the multiobjective optimization processes that are yet to be used in
biomechanical studies up to date, whereas machining, dental, and material demands must be considered. There is a
need to further analyze and further information on the
machining characteristics and machining-induced surface of
dental bioceramics and FGM dental implants to improve
quality, efciency, boneimplant contact, and cost
production.
Depending on the clinical advantage required for,
merged with the regulatory landscape, the commercial developmental efforts will nally provide new products with
novel and unique properties.

CONCLUSIONS

Close studies of natural tissue and organs illustrate that

they are not homogenous and natural functional gradients
exist in their formation. Biomaterial and tissue engineering
research literature shows that there is a requirement in
developing implants with FGM. Therefore, the great potential of FGM lies not only in the eld of bone tissue engineering but also in dentistry. To improve the acceptance of dental implants inside the living bone, the concept of FGM is a
favorable approach. The works reviewed here show that the
development of functionally graded dental implants and porous functionally graded dental implants is feasible for

DENTAL IMPLANTS FROM FGM

REVIEW ARTICLE

commercial dental implants. Porous functionally graded

dental implants were reviewed to improve mechanical properties, especially Youngs modulus as the high stiffness of Ti
generally is not well-matched to bone, which can lead to
stress shielding of the residual bone, which in turn may
result in detrimental resorptive bone remodeling.
There are a variety of techniques for producing FGM
dental implants and gradients of porosity. However, these
structures are largely still in the stage of laboratory
research. The obstacle may be the producing cost, which
will prevent the realization of the potential of FGM dental
implants. Also, more tests and studies are needed with
regard to design and production of combinations of bioinert
and bioactive materials for FGM for dental implants.

16.

17.

18.

19.
20.

ACKNOWLEDGMENTS

The authors are grateful for the grants.

21.

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